2001-10-04_REPORT - M1996052

• Permit No: M1996052
• IBM Index Class Name: Report
• Doc Date: 10/4/2001
• Doc Name: Annual Fee/Report/Map
• From: Owens Brothers Concrete Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

OCT-01-04 13:47 FROM-Colorado Division of Minerals 1. Geolosy [phone] T-61T P.002/002 F-40T
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ANNITAT.FRE and RETORT RF(NTV-RT Pf ED
PERMfPPEE NAME: Owens Brothers Concrete Company OCT 0 4 2004
PERMIT NO.: M-1996-052 oivisi : , t;.. ..;-at3&GeoloOv
OPERATION NAME: Del Camino Sand and Gravel Minc
ANN1vERSARY DATE: August 4,2004
ANNUAL FEE DUE: S688.00(Due on or before your anniversary date)
COUNTY: Weld
According to C.RS. 34-32.5-116 or C.R.S. 34-32-116,each year,on the anniversary date of the permit,an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year,the dates for the beginning
of active operations,and the date active operations ceased for the year,if any.
Please attarb ynnr ray'"d written annual report and annlia. 1 report mays to ibis farm_ Please note Aw an
adequately labeled map that clearly delineates and Includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
PermitteeContact: William M.Owens
Permitwc Name: Owens Brothers Concrete Company
Address: 5550 Sheridan Blvd-
Arvada,CO 80002 _
Phone Number. [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer,Owner,or Designee
in / ) )'-Lm �l
Date